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Obstacles to Reducing Medical Error

Both the United States and Japan try to reduce occurrences of injury and death due to medical error. Health officials in both countries realize that to develop successful quality-improvement programs, they must obtain accurate information on the nature, frequency and cause of medical errors.

Law professor Robert B. Leflar says both nations struggle with this problem because obtaining information about mistakes by health-care providers creates tension between the goals of patient safety and public accountability.

Leflar spent a year in Tokyo studying how people and institutions there deal with medical error. He discovered that the Japanese approach differs from U.S. methods, and says both countries can learn from each other.

The two countries differ in the type of law used in medical error cases. In the United States, medical error is almost always treated as a civil matter. In Japan, it is often treated as a criminal matter.

“In the United States, errant physicians and hospitals fear malpractice lawyers,” Leflar said. “In Japan, the greater concerns are whistleblowers, the media and the police.”

A lack of accountability mechanisms in the Japanese health-care industry appears to explain the criminal-law preference. In the United States, medical accountability is strengthened by peer review, codes of professional ethics, hospital accreditation and fear of civil litigation. Leflar found that although some Japanese hospitals report medical errors voluntarily, the absence of accountability mechanisms means it’s not mandatory.

Japan’s health ministry has developed a project whereby independent, neutral groups of medical specialists investigate medical accidents. They hope to obtain facts and reach conclusions more quickly, less expensively and perhaps more accurately and objectively than the legal system allows.

“If the Japanese project succeeds,” Leflar said, “American reformers seeking to link patient safety and improvement of the medicolegal dispute-resolution system may find the Japanese approach instructive.”